Dilator



M. M. MILLER July 27, 1965 DILATOR 2 Sheets-Sheet 1 Filed May 10. 1961INVENTOR ATTORNEY July 27, 1965 M M. MILLER 2 Sheets-Sheet 2 Filed May10. 1961 R m m V m M4U/9/CE M 44/4156 ATTORNEY United States Patent3,196,876 DILATOR Maurice M. Miller, 207 Medical Towers, Norfolk, Va.Filed May 10, 1961, Ser. No. 109,075 1 (Jlaim. (Cl. 128-343) The presentinvention relates to the class of surgical instruments and moreparticularly to a dilator for exploration of the common duct anddilatation of the Sphincter of Oddi.

On many occasions, the common duct is opened to search for and removestones. Certain indications for exploration of the common duct have beendevised and whenever one or more of these indications are present, theduct is most often explored. Some of the common indications are: when astone is palpable in the common duct; when the common duct is dilated;when there are small stones present in the gallbladder; when jaundice ofthe obstructive variety is present and various others. After the commonduct has been opened and explored for stones, it is necessary to dilatethe Sphincter of Oddi. This is done to encourage and facilitate passageof residual stones or debris left in the common duct. The Sphincter isalso dilated to make sure that there is no stricture of the Sphincter ofOddi or stone present in the ampulla.

The usual procedure in this type of operation has been to make alongitudinal incision in the anterior surface of the common duct justdistal to the entrance of the cystic duct for the entrance of the probe.The usual probe used for this purpose comprised a malleable metal rodapproximately fifteen inches in length and having a portionapproximately twice the length of the probe portion and an enlargedportion at the end of the probe portion. The probe is passed through theincision with the probe shaped to fit the curve of the common duct andits enlarged tip forced through the Sphincter of Oddi into the duodenum,thereby dilating the Sphincter of Oddi. To increase the dilation it hasbeen customary to provide a plurality of probes, each having anincreasingly larger tip, and successively inserting and removing thevarious probes.

The preceding steps not only increase the time of the probing operationdue to the fact that each probe must be separately shaped to fit thecurve of the common duct, but the insertion of the various probesincreases the danger of tearing the common duct or pushing a hole in aportion of the common duct in an area not visible to the operator.

The primary object of the present invention is to provide a dilatorwhich is much more rapid in its operation and which lessens the chancesof tearing the common duct.

The present invention contemplates the use of a single probe or dilatorwhich is similar in design to the first probe described above but havinga substantially rigid handle portion approximately ten inches long and amalleable probe portion about five inches long and terminating in anenlarged oval tip. The handle portion is squared to permit easy handlingand firm control of the instrument. In addition, there is a plurality ofsleeve dilators made of a very malleable material. The sleeve dilatorsare hollow and the diameter of the hollow opening is slightly largerthan the diameter of the probe and slightly smaller than the diameter ofthe enlarged oval tip whereby the sleeve may be pushed down over theentire length of the probe until its tip reaches and is stopped by theenlarged oval tip of the probe. The tip end of each sleeve is also ovalshaped and slightly enlarged with the diameter of the tip of the firstsleeve about 1 mm. larger than the diameter of the probe tip 3,196,876Patented July 27, 1965 which is approximately 3 mm. in diameter. Thediameter of the tip of the second sleeve is 5 mm., the diameter of thetip of the third sleeve 6 mm. and so on whereby each succeeding sleevepresents a slightly larger dilator.

Thus, the primary object of the invention is to provide a combined probeand dilator in the form of a probe having a dilating tip and a pluralityof sleeve like dilators wherein the probe serves as a guide for thesleeve dilators.

Other objects and advantages of the present invention will be readilyapparent from the following detailed description taken inconjunctionwith the accompanying drawings wherein:

FIGURE 1 is an elevational view of the probe members;

FIGURE 2 is a similar view of one of the sleeve dilators;

FIGURE 3 is a similar view showing the dilator of FIGURE 2 mounted onthe probe shown in FIGURE 1;

FIGURE 4 is an enlarged detail view of the device shown in FIGURE 3 withthe sleeve dilator shown in section;

FIGURE 5 is a sectional view taken on line 55 of FIGURE 4;

FIGURE 6 is a sectional view taken on line 66 of FIGURE 4;

FIGURE 7 is a sectional view taken on line 77 of FIGURE 4;

FIGURE 8 is a view similar to FIGURE 7, but showing a sleeve dilatorwith a slightly enlarged tip;

FIGURE 9 is a view of the duct system showing the probe inserted;

FIGURE 10 is a similar view showing the probe with a sleeve dilatormounted thereon.

Referring to the drawings in detail, and particularly to FIGURES 9 and10, showing the duct system, numeral 12 denotes the common duct, numeral13 indicates the hepatic ducts, numeral 14 denotes the duodenum andnumeral 15 denotes the Sphincter of Oddi. The incision in the commonduct is denoted by numeral 16, held apart by silk threads 17 to permitentrance of the probe member 18.

The probe member 18, shown in FIGURE 1, is approximately fifteen inchesin length, consisting of a substantially rigid handle portion 19 teninches in length and a malleable probe portion 20 five inches in length.The malleable probe portion terminates in an enlarged, oval-shaped tipportion 21 having a cross-sectional diameter of 3 mm. The probe portion20 has a diameter of approximately 2 mm. and the handle portion 19 issquared to permit easy handling and firm control of the instrument. Theprobe is made of any suitable metal commonly used for surgicalinstruments.

The sleeve dilator, indicated by numeral 22, comprises a hollow sleeveformed of malleable material having an internal diameter slightly largerthan the diameter of the probe but slightly smaller than the diameter ofthe probe tip 21 whereby the sleeve may encompass the probe and slidealong the probe until stopped by the bulbous tip of the probe. Thesleeve shown in FIGURE 2 has an enlarged oval-shaped tip 23 having anoutside cross-sectional diameter of approximately 4 mm. As previouslydescribed, a plurality of sleeves are provided wherein the tip is madeof a larger diameter than the previous sleeve and FIGURE 8 shows such asleeve wherein the tip 23 has an outside diameter of 5 mm. It will beunderstood that the hollow inner diameter of each sleeve is constant butthe dilator or top portion increases in diameter in increments of 1 mm.each.

The instrument of the present invention is used in the following manner:

On most occasions, the common duct is opened to search for and removestones. The probe 18 is inserted into the common duct 12 throughincision 16. The malleable portion 20 may be easily shaped to fit thecontour of the common duct. The probe is then further manipulatedwhereby the tip end of the probe passes through the Sphincter of Oddi todilate same. Once the guide probe has been successfully inserted throughthe common duct into the duodenum, it remains in position and serves asa guide for further dilation of the Sphincter of Oddi, by threading thesleeve dilators over the guide probe as shown in FIGURE 10. The bulboustip of the guide probe is easily felt through the wall of theduodenum,and the sleeve dilator also, since its tip is stopped by the tip of theguide probe.

It will thus be seen that the instrument described above is well adaptedto accomplish the advantages and objects set forth.

While I have described a preferred form of probe and dilator, it is tobe understood that various changes and modifications may be made hereinwithout departing from the spirit of the invention as defined in theappended claim.

Having thus described the invention, what is claimed A dilatorcomprising an elongated rod having a handle portion and a malleableprobe portion of substantially constant diameter throughout, said probeportion having an enlarged tip portion at its end opposite the handleportion, and a removable malleable sleeve slidably mounted on said rod,said sleeve having an internal diameter slightly larger than thediameter of the rod but smaller than the tip portion whereby said tipportion forms a stop for said sleeve, said sleeve having an enlargedportion on the end thereof adjacent the enlarged tip portion.

References Cited by the Examiner UNITED STATES PATENTS 672,377 4/01Kearns 128341 2,106,707 2/38 Greth 128341 2,221,138 11/40 Hendrickson12834l FOREIGN PATENTS 439,133 11/35 Great Britain.

1,878,671 9/32 Cantor.

RICHARD A. GAUDET, Primary Examiner.

JORDAN FRANKLIN. Examiner.

